This year there is virtually complete agreement among doctors that sugared drinks cause the highest rises in blood sugar that cause a fatty liver that can lead to diabetes.
• Endocrinologists reviewed 36 recent studies showing that taking just two servings a week of sugared drinks causes decreased insulin sensitivity, inflammation, high cholesterol and high blood pressure that are associated with increased risk for obesity, diabetes, heart attacks and strokes (Journal of the Endocrine Society, Nov 2, 2017).
• Cardiologists found the same association (Curr Opin Cardiol, Sept 2017 ;32(5):572-579).
• The Women’s Health Across the Nation study showed that calorie-dense drinks, particularly those with sugar, are associated with increased risk for obesity and diabetes in African American, Chinese, Japanese, and non–Hispanic white midlife women from six US cities and that the more sugared drinks they took, the greater their chances of developing diabetes and being obese (J Acad Nutr Diet, Dec 6, 2016).
• Pediatricians found that sugared drinks increase the markers of diabetes in children: elevated C-reactive protein, increased waist circumference, decreased good HDL cholesterol (Journal of the Academy of Nutrition and Dietetics, Feb 2013;113(2):219-27).
• Internal medicine researchers showed that sugared drinks are linked to obesity (Quarterly J of Med, April 26, 2017).

How Sugared Drinks Lead to Diabetes
All sugared drinks, including fruit juices, can cause high rises in blood sugar. The sugar in fruit juice can cause as high a rise in blood sugar as Coca Cola does.
• Your body tries to protect you from too much blood sugar by converting extra sugar almost immediately to a type of fat called triglycerides, so a high rise in blood sugar causes a high rise in triglycerides.
• High triglycerides can cause clots to form in your blood vessels, so your good HDL cholesterol works to protect you by carrying the triglycerides from your bloodstream to your liver.
• Triglycerides moved from your bloodstream into your liver cause the liver to fill up with fat, and a fatty liver can cause diabetes. People who are genetically susceptible to have high triglycerides are at very high risk for diabetes (Nutrigenet Nutrigenomics, Oct 2017;10(3-4):75-83).

Everyone's blood sugar rises after meals. To keep your blood sugar from rising too high, your pancreas releases insulin which lowers blood sugar by driving sugar from the bloodstream into your liver. As the fat in your liver increases, the ability of your liver to accept sugar decreases, allowing the sugar to accumulate in your bloodstream and potentially to damage every type of cell in your body.

How to Tell if You Have a Fatty Liver
You can suspect that you have too much fat in your liver if you have:
• blood sugar greater than 140 an hour after eating
• fasting triglyceride level greater than 150 mg/dl
• systolic blood pressure greater than 120 just before going to bed
• HDL cholesterol below 40 mg/dl
• waist circumference greater than 40 inches in a man or 35 inches in a woman
• more than three inches of fat underneath your skin when you pinch near your belly button
If any of these apply to you, your doctor can order an inexpensive and harmless sonogram of the liver which will demonstrate whether you have excess fat there.

The most important treatment for type II diabetes is to get the fat out of your liver so your liver can do its job of lowering blood sugar by removing sugar from your bloodstream. Some people who are genetically susceptible to diabetes will need to lose excess fat from the rest of their bodies before it will come out of the liver. High triglycerides can be lowered by exercising, losing excess weight and avoiding foods that cause high rises in blood sugar: all sugared drinks including fruit juices, sugar added foods and other refined carbohydrates such as bakery products and pasta. I recommend Intermittent Fasting

About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities.
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